Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0300X | Periodontist | 009974 | GA |
NPI | 1114051273 |
---|---|
Provider Name | Jeffrey Scott Sherry |
First Address | Douglasville, GA 30135-6935 |
Second Address | Douglasville, GA 30135-6935 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/03/2007 |
Last Update Date | 08/07/2007 |